Month: March 2010

Pharmacists pride themselves as being the most accessible health professionals. In community pharmacy settings, pharmacists speak with hundred of patients per day, and are available (free, and without an appointment) for quick consultations. Building good relationships is a rewarding part of being a pharmacist, and the level of trust that can develop supports open dialogue on health issues.

So as a pharmacist, how do you react when one of your patients indicates antagonism to vaccines? Attitudes can range from from mild unease, to full-blown conspiracy theories. The reasons for rejection can be numerous. A first step to supporting open dialogue would be to understand the usual reasons for vaccine rejection.

Civil Liberties: Civil liberty arguments appeal to parental/self rights and make accusations of totalitarianism/fascism. (One argument I noted before the H1N1 vaccine arrived in Canada were claims that the military was prepared to force vaccination on all citizens of Canada.) A common story is that of a parent who had their child taken away by social services for not being immunized.

Conspiracy Theories: Conspiracy theories are endemic, and showed up on every antivaccination site reviewed. Anti-science rhetoric is common. Sites almost always claim there is a mass cover-up involving manufacturers, governments, regulators, and health professionals. Typical claims include:

physician that speak out against vaccines (e.g., Andrew Wakefield) are lauded or martyred, no matter how discredited

vaccination is a tool to kill/sterilize/exert mind control of the population

Morality, Religion, and Ideology: Morality and religious objections were identified on 25% of web sites surveyed. Common arguments included:

God created a perfect immune system

vaccines are cultured in the tissue of aborted fetuses

animals are tortured in the manufacture of vaccines

vaccines are tested on children in third world countries

Misinformation and Falsehoods: Demonstrably false statements are common on antivaccination sites. The authors noted that there is no evidence of self-criticism in the anti-vaccination community, where unsupportable statements were rarely challenged. Misinformation can be difficult to spot without knowing the data, but commonly includes:

misleading interpretations of vaccine studies

misleading use of statistics

false statements about the presence/absence of thimerosal in vaccines

statistics/prevalence of communicable disease or diseases such as autism

Interestingly, the only website noted to be free of misinformation was Wikipedia’s “Vaccine Controversy” page, which, at the time the author did her survey, was “current, unbiased, and properly referenced.” It was felt to be the most credible and balanced of all the websites surveyed.

Emotive Appeals: Personal testimonials are very common, and typically include narratives from parents who attribute injury to vaccines. Interactions with government, medicine, and the scientific establishment are positioned as “us versus them” battles.

What’s a pharmacist in a postmodern society to do?

As long as there have been vaccinations, there have those that oppose them. The underlying themes have changed little since the 18th century, despite the demonstrable successes of vaccines. Kata suggests this indicates the presence of deeper social and political tensions that manifest as different arguments, depending on the era: Where civil rights and government distrust were historically more common, today, rejection of scientific evidence and of the science-based model of disease seems more prevalent, with a growing embrace of different (non-science-based) models of disease. But each person’s reason for rejection may be different, and it may manifest in how they interact with health care professionals. Some may trust the pharmacist, and others may see the pharmacist as just a cog in the industrial-pharmaceutical complex.

The internet brought democratization of information. Web 2.0’s social networking has led to the evolution of new social networks that make it easy for anyone with fears of vaccines to find the confirmation bias needed to reassure themselves that vaccines are bad. Kata implicates much of the modern antivaccination sentiment to postmodern concepts of society. To the postmodernist, there are no facts, only truths, and all truths are socially constructed. Because they’re socially constructed, they are subject to the biases and prejudices of the observer. This places the observer as the final arbiter of truth, regardless of expertise. To the post modernist, even basic science is to be questioned, because how can we “REALLY” know? The consequence of postmodernism is that the opinion of the pharmacist or physician becomes just that: one opinion that is considered alongside all others, including those without any relevant expertise or education.

It’s clear that the reasons for antivaccination sentiment can vary, and not all arguments are amenable to the simple provision of education or evidence. Having an understanding of the underlying issues that each patient may bring forward, and their underlying perspective on science, facts, and evidence can help pharmacists comprehend the nature of common anti-vaccine arguments. By keeping the lines of communication open, and being prepared to recognize vaccine misinformation, pharmacists can work to build trust and reinforce their voice as credible, trusted sources of information.

To our health professional readers: What are your strategies for dealing with anti-vaccine sentiment among your patients?

Part fills is an irregular feature bringing you updates on relevant issues, and highlights from other blogs. Enjoy! Continue reading →

It’s Pharmacy Awareness Week. You’re probably not aware of this, neatly illustrating the challenge pharmacists have in raising their professional profile with the public. Despite what you may read here in this blog (written by me), pharmacists do a lot more than sell unproven supplements. Beyond their important role in ensuring safe and effective prescription drug therapy, pharmacists are gaining expanded professional responsibilities. Some jurisdictions are allowing pharmacists limited prescribing privileges, and the right to modify prescription therapy without the need to consult a physician. But it’s the right to administer vaccines that is among the most interesting new acts being given to to pharmacists. And it makes sense. Pharmacists are the most accessible health professionals, and are well positioned to support vaccination programs. And vaccination programs need support. Continue reading →